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Participants were assessed at baseline and 12\u00a0months with the Pediatric Sleep Questionnaire\u2013Sleep-Related Breathing Disorder (PSQ-SRBD) scale and polysomnography (PSG). We tested for factors predictive of either (1) PSG progression defined by a 12-month oAHI\u2009\u2265\u20093 or (2) symptom persistence or progression defined by a 12-month PSQ-SRBD score\u2009\u2265\u20090.33.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 234 participants were observed (mean age 6.2\u00a0years, 111 [47%] female, 65 [28%] Black or African American, 37 [16%] Hispanic). Overall, only 13% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920\/150) progressed to an oAHI\u2009\u2265\u20093 on repeat PSG, whereas over half (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009110\/192, 57%) had symptom persistence\/progression. Of the children with persistent or progressive symptoms, 18% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916\/103) progressed to oAHI\u2009\u2265\u20093. In unadjusted analyses, PSG progression was associated with Black race (OR 2.71, 95% CI 1.03\u20137.17) and higher baseline PSQ-SRBD (OR 1.74, 95% CI 1.03\u20133.08). Symptom persistence\/progression was predicted by asthma (OR 2.70 [95% CI 1.29, 6.01]), ADHD (OR 3.73 [95% CI 1.13, 16.88]), and tobacco smoke exposure (OR 2.41 [95% CI 1.08\u20135.82]), while children with larger tonsils (grade III\u2013IV) had lower odds of progression (OR 0.42 [95% CI 0.22\u20130.78]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A high symptom burden is common after a year of WWSC for mild SDB, but only a minority of children progressed on PSG. Black race and several clinical characteristics and symptom scores were associated with higher likelihood of progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier: NCT0256204.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Brief summary<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Current knowledge\/study rationale<\/jats:title>\n                    <jats:p>Can clinical information predict persistence or progression of mild sleep-disordered breathing in children who are observed for 1\u00a0year without adenotonsillectomy?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study impact<\/jats:title>\n                    <jats:p>Polysomnographic progression to obstructive sleep apnea occurs in a minority (13%) of those observed while symptom persistence or progression is more common (57%). Children who are Black or who have asthma, attention-deficit hyperactivity disorder, environmental tobacco exposure, and a high symptom burden could be considered stronger candidates than their peers for earlier adenotonsillectomy for symptomatic mild sleep-disordered breathing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44470-026-00082-y","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:15:47Z","timestamp":1783444547000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Progression of mild sleep-disordered breathing in children managed with watchful waiting"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-3022","authenticated-orcid":false,"given":"Erin M.","family":"Kirkham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Ishman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Garetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina M.","family":"Baldassari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron B.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio E.","family":"Tapia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Elden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauziya","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqi","family":"Cen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Redline","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald D.","family":"Chervin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"issue":"2","key":"82_CR1","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1513\/pats.200707-111MG","volume":"5","author":"ES Katz","year":"2008","unstructured":"Katz ES, D\u2019Ambrosio CM. 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Informed consent was obtained from parents or guardians and assent from children 7\u00a0years or older upon enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Kirkham reports authorship for UpToDate and grants from NIH. Dr. Ishman reports consulting fees from Ethicon and Procter & Gamble and research funding from Nyxoah and Inspire. Dr. Baldassari reports grants from Inspire, American Academy of Otolaryngology\u2013Head & Neck Surgery, and NIH as well as a consulting fee from Nyxoah. Dr. Hassan reports serving as a consultant for Eli Lilly. Dr. Ibrahim reports research-related funding from NIH, Jazz Pharmaceuticals, and Avadel Pharmaceuticals. Dr. Ross reports grants from NIH and grants from AstraZeneca, GlaxoSmithKline, and Sanofi and fees from AstraZeneca for advisory board participation. Dr. Tapia reports authorship for UpToDate and grants from NIH. Dr. Elden reports grants from NIH and Inspire. Dr. Redline reports grants from NIH and consulting fees from Eli Lilly. She is an unpaid advisor to ApniMed and an unpaid board member for the non-profit Alliance for Sleep Apnea Partners and the National Sleep Foundation. Dr. Chervin reports a financial relationship that may be pertinent: consulting for Eli Lilly and Company, through a contract between Eli Lilly and Michigan Medicine; editor and author for UpToDate; named in patents and questionnaires copyrighted by the University of Michigan and designed for assessment and treatment of sleep disorders (this includes the Pediatric Sleep Questionnaire\u2013Sleep-Related Breathing Disorder scale, licensed by the University of Michigan for management by Mapi Research Trust); non-financial interests: serves as a member, board of directors, and officer, International Pediatric Sleep Association; serves as a member, advisory board, for the non-profit Pajama Program. Dr. Wang reported grants to institution from NIH. All other authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"106"}}